Radiology mcq -- neuro module

Q1.  A 50 yr old patient with AIDs presents with an insidious onset of dementia . Visual loss, weakness, ataxia, and speech disturbances are also noted  .The patients died within six months . Brain biopsy shows confluent areas of demyelination,distributed throughout the cerebral white matter .Microscopically, there are multiple foci of demyelination. There are atypical oligodendrocytes containing large, swollen nuclei with basophilic / eosinophilic inclusion bodies and  reactive astrocytes .What is the most likely diagnosis

a.PML        

b.lymphoma

c.toxoplasmosis

d.HIV-1 encephalopathy

e.CMV

Q2.All features are suggestive of PML except

a. more frequent involvement of parietal white matter

b.usually absent enhancement  on MR

c. posterior fossa involment

d. absent  optic nerve involvement

e. spinal cord involvement common

ANS--

Q1---a

Q2---e

                       

Spinal cord involvement is extremely rare in PML. Mass effect is more common with lymphoma and toxoplasmosis but can occasionally be present in PML. Encephalitides, including  cytomegalovirus, toxoplasmosis, or HIV-1 encephalopathy may mimic PML in case of AIDS patients.